Clinical Analysis and Treatment of Esophageal Perforation

Park, Hoon; Keum, Dong Yoon; Park, Nam Hee; Park, Chang Kwon; Lee, Kwang Sook

Abstract

BACKGROUND: Perforation of the esophagus is a deadly injury that requires expert management for survival. The mediastinal contamination with microorganisms, gastric acid, and digestive enzymes results in a mediastinitis that is often fatal if untreated. MATERIAL AND METHOD: Between January 1990 and June 2004, 38 patients with esophageal perforation were treated in our hospital. Retrospective review of these cases has been performed. RESULT: There were 28 males and 10 females. The mean age was 43.84+/-18.89 years (range 1~73 years). Spontaneous rupture was found in 34% of perforations, iatrogenic perforation in 32% and traumatic perforation in 34%. Perforation occurred in the cervical esophagus in 8 cases, thoracic esophagus in 29 and abdominal esophagus in 1. In the cervical esophageal perforation, managements were primary closure in 8 and drainage in 2. In the thoracic esophageal perforation, managements were primary closure in 14, resection in 3 and conservative management in 12. The mortality rate was 25% in cervical esophageal perforation and 34.5% in thoracic esophageal perforation. We revealed risk factor of esophageal perforation to be peropertaive septic condition (p=0.005).
CONCLUSION
Most important risk factor of esophageal perforation was preoperative septic condition. Preoperative prompt and aggressive preoperative treatment may improve the survival rate of esophageal perforation.